Ketamine as an Adjunctive Therapy for Major Depression (KARMA-dep)
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| ClinicalTrials.gov Identifier: NCT03256162 |
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Recruitment Status :
Completed
First Posted : August 21, 2017
Results First Posted : January 18, 2020
Last Update Posted : January 18, 2020
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| Condition or disease | Intervention/treatment | Phase |
|---|---|---|
| Major Depressive Episode Unipolar Depression Bipolar Depression | Drug: Ketamine Drug: Midazolam | Phase 1 |
| Study Type : | Interventional (Clinical Trial) |
| Actual Enrollment : | 25 participants |
| Allocation: | Randomized |
| Intervention Model: | Parallel Assignment |
| Masking: | Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor) |
| Primary Purpose: | Other |
| Official Title: | Ketamine as an Adjunctive Therapy for Major Depression - a Randomised Controlled Pilot Trial: The KARMA-Dep Trial |
| Actual Study Start Date : | September 7, 2017 |
| Actual Primary Completion Date : | September 21, 2018 |
| Actual Study Completion Date : | September 21, 2018 |
| Arm | Intervention/treatment |
|---|---|
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Experimental: Ketamine
Participants will receive four once-weekly infusions of ketamine at 0.05mg/kg. All infusions will be administered by a consultant anaesthetist.
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Drug: Ketamine
A sub-anaesthetic dose of ketamine will be administered in four infusions, each one week apart.
Other Name: Ketalar |
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Active Comparator: Midazolam
Participants will receive four once-weekly infusions of midazolam at 0.045mg/kg. All infusions will be administered by a consultant anaesthetist.
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Drug: Midazolam
A sub-anaesthetic dose of midazolam will be administered in four infusions, each one week apart.
Other Name: Hypnovel |
- The Hamilton Rating Scale for Depression-24 Item Version (HRSD-24) [ Time Frame: 15 weeks ]
The HRSD assesses severity of depressive symptoms and is commonly used to measure depression severity. It was initially a 17-item format with the optional addition of 4 items making up the 21-item version. In addition to the original 21 items, the 24-item HRSD includes items on helplessness, hopelessness and worthlessness; its score range is 0-77, with higher scores reflecting greater burden of depressive symptoms.
Response to antidepressant treatment is defined as achieving ≥60% decrease from baseline HRSD-24 and score ≤16. Remission criteria are ≥60% decrease in HRSD from baseline and score ≤10. Criteria for relapse are ≥10 point increase in HRSD-24 compared to responder baseline score plus HRSD ≥16; in addition, increase in the HRSD should be maintained one week later.
Participants will have a baseline (T0) HRSD-24 score. This will be repeated 1 week after each of 4 once-weekly infusions (T1-4) and follow-up measures after another 5 (T9) and 11 (T15) weeks, week 15 is reported.
- The Quick Inventory of Depressive Symptoms, Self-report Version (QIDS-SR16) [ Time Frame: 15 weeks ]
The QIDS-SR16 is a validated self-report measure of depressive symptoms. This consists of 16 questions rated 0-3. Its score range is 0-48, with higher scores reflecting greater burden of depressive symptoms.
Participants will have a baseline (T0) QIDS-SR16 score. This will be repeated one week after each of four once-weekly infusions (T1-4) and follow-up measures after another five (T9) and 11 (T15) weeks. Week 15 scores are reported.
- The Clinician-Administered Dissociative States Scale (CADSS) [ Time Frame: 4 weeks ]
The CADSS measures dissociative symptoms. It will be administered before, during and after infusions in order to capture the range of possible subjective side effects of either agent. This consists of 23 questions and scores for each question range from 0-4. The maximum score is 92 with higher scores indicating more dissociative symptoms.
Participants will have the CADSS performed before, during (+30mins) and after (+60mins) each of the four once-weekly infusions.
- The Brief Psychiatric Rating Scale (BPRS) [ Time Frame: 4 weeks ]
The BPRS measures psychotomimetic effects. The investigators will use the positive symptoms subscale of the Brief Psychiatric Rating Scale. The 4-item positive symptoms subscale measures suspiciousness, hallucinations, unusual thought content, and conceptual disorganisation. Each question is scored between 0-7. The maximum score in this 4-item questionnaire is 28. Higher scores indicate more severe psychotic symptoms.
Participants will have the BPRS performed before, during (+30mins) and after (+60mins) each of the four once-weekly infusions.
- Young Mania Rating Scale (YMRS; Mood Item) [ Time Frame: 4 weeks ]
Investigators will use the mood item of them YMRS to assess for psychotomimetic effects. This item is rated 0-4. The higher scores reflect elevated mood.
Participants will have the YMRS performed before, during (+30mins) and after (+60mins) each of the four once-weekly infusions.
- The Patient-Rated Inventory of Side Effects (PRISE) [ Time Frame: 4 weeks ]
The PRISE will be used to document other general adverse events by patients before, during and after infusions. This is a patient self-report used to qualify side effects by identifying and evaluating the tolerability of each symptom. It is a 9 item assessment of the side effects in the following symptom domains; Gastrointestinal, Heart, Skin, Nervous System, Eyes/Ears, Genital/Urinary, Sleep, Sexual Functioning, and Other. Each domain has multiple symptoms which can be endorsed. For each domain the patient rates whether or not the symptoms are tolerable or distressing. Data below represent the number of participants from which there was an endorsement of each listed event.
Participants will have the PRISE performed before, during (+30mins) and after (+60mins) each of the four once-weekly infusions.
- The Montreal Cognitive Assessment (MoCA) [ Time Frame: 15 weeks ]
The MOCA was designed as a rapid screening instrument for mild cognitive dysfunction. It assesses different cognitive domains: attention and concentration, executive functions, memory, language, conceptual thinking, calculations, and orientation. It is scored out of a maximum of 30. The higher scores indicate better cognition.
The MOCA will be performed at baseline, one day after infusions 1 and 4 and 12 weeks after the final infusion.
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| Ages Eligible for Study: | 18 Years and older (Adult, Older Adult) |
| Sexes Eligible for Study: | All |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- ≥18 years old
- Hamilton Rating Scale for Depression-24 item version (HRSD-24) score of ≥21
- Voluntary admission for treatment of an acute depressive episode
- Meet Diagnostic and Statistical Manual of Mental Disorders , Fifth Edition (DSM-V) criteria for a major depressive disorder (MDD) and bipolar affective disorder (current episode depression)
Exclusion Criteria:
- Current involuntary admission
- Medical condition rendering unfit for ketamine/midazolam
- Active suicidal intention
- Dementia
- History of Axis 1 diagnosis other than major depression
- Electroconvulsive Therapy (ECT) administered within the last two months
- Alcohol/substance dependence in previous six-months
- Pregnancy or inability to confirm use of adequate contraception during the trial
- Breastfeeding women
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03256162
| Ireland | |
| St Patrick's University Hospital | |
| Dublin, Ireland, D8 | |
| Principal Investigator: | Declan M McLoughlin, PhD | St Patrick's Mental Health Services and Trinity College Dublin |
Documents provided by Prof Declan McLoughlin, St Patrick's Hospital, Ireland:
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
| Responsible Party: | Prof Declan McLoughlin, Professor, St Patrick's Hospital, Ireland |
| ClinicalTrials.gov Identifier: | NCT03256162 |
| Other Study ID Numbers: |
01/17 2016-004764-18 ( EudraCT Number ) |
| First Posted: | August 21, 2017 Key Record Dates |
| Results First Posted: | January 18, 2020 |
| Last Update Posted: | January 18, 2020 |
| Last Verified: | January 2020 |
| Individual Participant Data (IPD) Sharing Statement: | |
| Plan to Share IPD: | No |
| Studies a U.S. FDA-regulated Drug Product: | No |
| Studies a U.S. FDA-regulated Device Product: | No |
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ketamine glutamate |
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Depression Depressive Disorder Bipolar Disorder Behavioral Symptoms Mood Disorders Mental Disorders Bipolar and Related Disorders Midazolam Ketamine Analgesics Sensory System Agents Peripheral Nervous System Agents Physiological Effects of Drugs Anesthetics, Dissociative Anesthetics, Intravenous |
Anesthetics, General Anesthetics Central Nervous System Depressants Excitatory Amino Acid Antagonists Excitatory Amino Acid Agents Neurotransmitter Agents Molecular Mechanisms of Pharmacological Action Adjuvants, Anesthesia Hypnotics and Sedatives Anti-Anxiety Agents Tranquilizing Agents Psychotropic Drugs GABA Modulators GABA Agents |